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State by State Disability News 11.11.16

Lead Story:   New York

The Department of Health received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the State’s Medicaid Plan to effectuate the Community First Choice Option (CFCO) as of July 1, 2015. CFCO will incorporate enhanced services and supports into the Medicaid State Plan for eligible individuals who need assistance with everyday activities due to a physical, developmental or behavioral disability. These services and supports will address activities of daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks through hands-on assistance, supervision and/or cueing. On April 1, 2017, the Department anticipates implementing CFCO for both fee-for-service and managed care enrollees. Medicaid beneficiaries must meet certain setting and needs-based criteria in order to be eligible for CFCO services. Local Departments of Social Services and Managed Care Organizations will be required to assess as well as authorize CFCO services/supports in addition to those services for which they currently assess and authorize. CFCO services must be provided pursuant to a Person Centered Service Plan (PCSP). CFCO State Plan services and supports include: Assistive technology beyond the scope of Durable Medical Equipment: These are items, pieces of equipment, product systems, or instruments of technology, whether acquired commercially, modified, or customized, that increase a consumer’s independence or substitutes for human assistance that would otherwise be authorized, e.g., personal care services. This service is subject to cost limitation. ADL and IADL skill acquisition, maintenance, and enhancement: This service is intended to maximize the consumer’s independence and/or promote integration into the community by addressing the skills needed for the consumer to perform ADLs and IADLs. ADL and IADL skill acquisition, maintenance, and enhancement may include assessment, training, supervision, cueing, or hands-on assistance to help a consumer perform specific tasks. Community Transitional Services: Assistance to consumers who are transitioning from an institutional setting to a home in the community. This service includes payments for first month’s rent and utilities, bedding, basic kitchen supplies, and other necessities required for a consumer to make the transition from an institutional setting. This service is subject to cost limitation. Moving Assistance: This service is available to consumers who are transitioning from an institutional setting to a community-based setting. This service covers the cost of physically moving the consumer’s furnishings and other belongings to the community-based setting where she or he will reside. This service is subject to cost limitation. Environmental Modifications: This service encompasses internal and external adaptations to a consumer’s residence that are necessary to ensure the consumer’s health, welfare and safety while enabling them to function with greater independence and prevent institutionalization. This service is subject to cost limitation. Vehicle Modifications: This service encompasses modifications to a vehicle that is the consumer’s primary means of transportation when said modifications are necessary to increase the consumer’s independence and inclusion in the community. This service is subject to cost limitation. Non-Emergent Transportation (social): The non-emergent transportation service is expanded to include transportation to and from non-medical activities such as social gatherings, religious services and other events in the community when the activity is related to a need identified through assessment and the PCSP process. Congregate and/or Home Delivered Meals: This service includes up to two meals per day for consumers who cannot prepare or access nutritionally adequate meals for themselves and the cost of this service is less than it would be to have someone provide in-home meal preparation. To read more –



Medicaid Commissioner Stephanie Azar urged lawmakers not to abandon a plan to change to a system of managed patient care, a sweeping change that might be in jeopardy because of uncertain funding. The Legislature’s contract review committee today temporarily blocked an $8.3 million, one-year contract renewal with a consulting firm that is helping Medicaid with the transition to regional care organizations, or RCOs. Sen. Bill Holtzclaw, R-Madison, the committee chairman, said lawmakers are experiencing “sticker shock” on the cost of the RCO transformation.  “Quite frankly, the goal lines continue to be moved by the federal government,” Holtzclaw said. Azar questioned that assertion and said she has always been clear that there would be implementation costs. She said no state could make such a sweeping change in Medicaid without using contractors. Azar said the long-range outlook for the transition, to slow the growth in Medicaid costs by better care management, remained sound, but needs a reliable source of funding. To read more –



The budget Gov. Asa Hutchinson outlined to state lawmakers Wednesday morning includes a $50 million tax cut, increases for education and foster care and no allocation of money for legislative and executive General Improvement Funds. Hutchinson described Arkansas’ budget proposal process as one of the best in the nation, saying it acts as a “safeguard against overspending even in uncertain economic times.” The governor, who is required by law to present a balanced plan each biennium, said “it does not take a Ph.D. in economics to know that we can’t say yes to every spending need,” adding that compromises must be made to prioritize the most pressing state needs.  Hutchinson said his plan incorporates savings Arkansas has already reaped partly due to the state hiring freeze and a consolidation of five state agencies. Executive actions, supported by the legislature, have eliminated more than 1,000 government positions, the governor said. Hutchinson also said savings will come from future streamlining such as moving War Memorial Stadium under the wing of the Department of Parks and Tourism. The Department of Human Services will also see $50 million in savings under his administration’s proposed plan, Hutchinson said. The governor then highlighted potential boosted funding for education, mental health services and the foster care system. Hutchinson suggested a $10 million increase to higher education for the second year of the biennium, saying his plan “rewards institutions for student success and not just student enrollment.” He also allocated $3 million to pre-kindergarten to improve the quality of classroom instruction and attract qualified teachers. Hutchinson said a task force recommended creating three “crisis stabilization centers” to help local law enforcement and first responders better serve mentally ill people who inundate county jails and prisons. He said $5 million should go toward the effort. The state foster care system is a compelling problem needing help as the number of children in the program grows year after year, Hutchinson said. He proposed increasing funding to the Division of Child and Family Services by $26.7 million in the 2018 fiscal year and $11.9 million in the 2019 fiscal year, saying “we cannot shortchange the children or our state responsibilities.” To read more –



San Francisco will set aside specific funding for the health care of senior citizens and adults with disabilities for the next two decades following the apparent passage of Proposition I on Tuesday. Prop. I, which required more than 50 percent of the votes to pass, creates a guaranteed chunk of cash — $38 million in the first year — that will increase over the next two decades for seniors and adults with disabilities.  While The City provides for seniors in a myriad of ways, there was not a special set aside fund specifically aimed at paying for such services. It’s estimated that by 2020, there will be an additional 100,000 senior citizens living in San Francisco.  Prop. I amend the charter to guarantee funding of such services by requiring a set aside from city funds. The new fund will be administered through the Department of Aging and Adult Services, and services include home health care, food and caregiver programs as well as community centers and advocacy programs. The fund will begin at a $38 million baseline, which was set because it represents what The City spent on such services in fiscal year 2016-17. It will grow by $6 million in the first year and then by $3 million each year until 2027 at which point it will cap at $72 million.  To read more –



Noah Homes, a nonprofit for adults with developmental disabilities, joined by elected officials and more than 30 community partners announced the completion of the first memory care homes in California, two of the first in the nation, specifically for people with developmental disabilities, including Down syndrome, Autism, cerebral palsy and others.  A ribbon cutting on this first-of-its kind project was held on November 3rd. Two 5,000 sq. ft. houses will open in early 2017 and become home to 20 people with developmental disabilities who have been diagnosed with aging issues, Alzheimer’s or another related dementia. The total project was estimated to cost $6.7 million and is less than $1 million from being completely funded. Residents are selected based off an interest list of adults with developmental disabilities receiving services through the San Diego Regional Center. Project partners are hopeful that plans will be replicated by other organizations throughout California and across the nation, alleviating some of the burden of the 15.5 million caregivers who provided an estimated 17.7 billion hours of unpaid care, valued at more than $220 billion in 2013. “Almost all people with Down syndrome will develop Alzheimer’s as they live into their 60s – starting as early as their 40s – and yet there are no homes specialized for their needs,” said Molly Nocon, CEO of Noah Homes. “As UC San Diego continues to advance research on Alzheimer’s, we are working with organizations around the country to advance quality of care for those affected – obviously, the need is much larger and this is just the beginning.”   For the first time in history, this underserved population of more than 280,000 people with developmental disabilities in California is dealing with issues related to aging, including Alzheimer’s and other forms of dementia. For instance, life expectancy for people with Down syndrome has increased dramatically in recent decades – from 25 in 1983 to an average age of 60 today. To read more –



Amendment 69, the ballot measure known as ColoradoCare that would have created a universal health care system in Colorado, was soundly defeated Tuesday night. At 8:30 p.m., with nearly 1.8 million votes counted across the state, the amendment was trailing 79.6 percent to 20.4 percent, according to preliminary state figures. Updated vote totals at 7 a.m., with 86 percent of the vote counted, the measure continued trailing at roughly the same percentage or 1,833,879 to 467,424. Throughout the campaign, the measure had polled better with Democrats than Republicans. But even in left-leaning Denver, the amendment was losing 2-to-1, according to early returns. At a downtown Denver watch party for supporters of the measure, the mood was quiet but not yet resigned to defeat. “The early returns, I hope, are not reflective of Colorado,” said state Sen. Irene Aguilar, a Denver Democrat who is one of the amendment’s leading backers. But supporters also acknowledged it was unlikely the measure would recover and vowed they would try again another year. To read more –



Colorado voters Tuesday said yes to a law allowing people who are terminally ill and expected to live six months or less to end their lives with the help of doctors. Colorado voters decisively passed Proposition 106, making it the state the sixth in the nation to allow sick people to opt for assisted suicide. The law is similar to one passed in Oregon 20 years ago, which allows patients to take prescription medications to end their lives after two doctors have determined they are sane and have fewer than six months to live. This means people with any type of dementia, including Alzheimer’s disease, would not be able to get a prescription. “This is a historic day for all Coloradans, and an especially tremendous victory for terminally ill adults who worry about horrific suffering in their final days,” said Barbara Coombs Lee, president of the Compassion and Choices Action Network. “We are delighted the significant investment paid off and are proud to have lent the expertise and resources to empower the voters of Colorado. We congratulate Colorado for becoming the sixth state where more people have peace of mind at the end of life and fewer suffer unnecessarily.” Colorado now joins five other states — Oregon, Washington, Vermont, Montana and California — as the only in the United States to permit assisted suicide. To read more –



Currently in Connecticut, private nonprofit agencies serve 91 percent of individuals with developmental disabilities and their families. We are prepared, poised and ready to serve more. Private nonprofit agencies are a vibrant group, located in the state’s diverse towns and cities. We are connected to the real needs of our communities. Families using our services for their children rely on state Department of Developmental Services and Medicaid funding to pay for them. Recently, DDS funding has steadily decreased, and Medicaid funding formulas have not been adjusted to bridge the gap. This makes it harder for families to make use of services and more difficult for the private nonprofit agencies to provide them. Worse, it means over 2,000 people in Connecticut with developmental disabilities are not served at all and live at home with aging parents — because no funding is available. State leaders must prioritize funding for people with disabilities. There must be an end to state budget cuts affecting people with developmental disabilities. We urge lawmakers to consider real solutions and vote “no” to any budget cuts to private nonprofit agencies across Connecticut that provide community-based services to people with disabilities.  To read more –



As the election dust settled Wednesday, there was little indication that the historic state budget impasse driven by Republican Gov. Bruce Rauner and Democratic House Speaker Michael Madigan would end any time soon. Republicans sought to parlay their net gain of four seats in the House and two in the Senate into pressure on Democrats to negotiate a blockbuster deal for Rauner’s legislative agenda. For their part, Democrats dismissed the GOP gains in the General Assembly as a “small victory.”  The public posturing came after both parties spent tens of millions of dollars each to wage political war on each other in roughly 30 legislative contests, most of them centered on the Madigan-controlled House. Republicans got their money from Rauner, a former private equity investor, and two wealthy allies, while Democrats piled up contributions from labor unions and trial lawyers. Rauner’s money paid for thousands of TV ads attacking Madigan, but on Wednesday the governor suggested it was time to move on.  This has been a long, grueling campaign cycle, both nationally and locally,” Rauner said in a statement. “For the good of the people of Illinois, let’s put the election behind us.” He called for Republicans and Democrats to come together on a budget, but said a spending plan must come “along with reforms.” That’s code for Rauner’s “Turnaround Agenda,” which he’s made a condition of a larger budget agreement, saying budget cuts and tax hikes will not fix the state’s financial mess alone but that businesses need to grow. Rauner’s ideas to limit payouts for workers hurt on the job, curb collective bargaining rights and change the rules on civil lawsuits have been non-starters among Democrats, who say the proposals would harm middle class workers and have little to do with the annual budget making process. To read more –



Days after the state announced it would inject an additional $33 million into the three private insurers managing the $4.6 billion Medicaid program, one managed-care organization already is saying the increased rates are not enough and hinted it is asking for more.  “In terms of Iowa …we did get a retroactive rate increase,” John Gallina, chief financial officer of Anthem, the parent company of Amerigroup Iowa, said during the company’s third-quarter earnings call on Wednesday. “Unfortunately, we think it still is not actuarially justified. We really are not providing an exact number at this point as we continue to work with the state, and don’t want to get out ahead of the state and negotiate this publicly.” Gallina went on to tell analysts that the company needs “to partner with states that want to be partners” and that Anthem will continue to negotiate higher “actuarially justified rates.” “We feel very good about that fact, but if we do not get it then we will have a decision to make in Iowa, as well,” he said during the call. Iowa handed its Medicaid program with nearly 600,000 recipients over to the MCOs — Amerigroup, AmeriHealth Caritas and UnitedHealthcare of the River Valley — on April 1.  On Monday — about seven months into Iowa managed care — state officials announced it would increase capitation rates, or the per-member per-month fees it pays the MCOs for the first rate period, which ends on June 30, 2017. The increase on the state’s end also came with an additional $94.5 million from the federal government. Iowa officials pointed to rising prescription drug prices and unexpected costs of new Medicaid enrollees as the primary factors for the rate increase. The move was criticized by many of the state’s Senate Democrats who said Gov. Terry Branstad and Department of Human Services officials, which oversees the Medicaid program, transitioned to managed care too quickly. To read more –



Kansas is preparing for a new fiscal forecast for state government that is expected to be more pessimistic in projecting the state’s tax collections than the current one. State officials, legislative researchers and university economists were meeting Thursday to draft revised projections for tax collections through June 2017. They also planned to issue the first projections for the following two years. Republican Gov. Sam Brownback, his staff and legislators use the numbers in budgeting. The current forecast was issued in April. From July through October, tax collections have been $80 million less than projected for a shortfall of 4.2 percent. The state already faces a projected shortfall of at least $70 million in its current, $15.5 billion annual budget. A more pessimistic forecast would make the gap larger.



If it wasn’t clear already, the LePage administration confirmed last week it has no interest in accountability or taking responsibility. Last Tuesday, state auditor Pola Buckley released a finding that the Maine Department of Health and Human Services had misspent $13.4 million in federal welfare funds legally earmarked for low-income families with children. The department instead spent the money on in-home services for elderly and disabled residents. Two LePage appointees responded swiftly by impugning the auditor’s motives — not by taking her finding seriously and taking responsibility for a serious failure in financial management. First, the administration questioned the timing of the audit finding’s release; questioned how the auditor’s letter to Gov. Paul LePage, the Legislature and Attorney General Janet Mills so quickly found its way to the news media; and alleged the audit was politically motivated.  But the administration seems to overlook the fact that state government belongs to Maine people. The auditor’s finding is a public document that addresses serious shortcomings in how DHHS handles the public’s money. If the administration cared enough to follow the law — and less about impugning the motives of others and alleging a political conspiracy — its leaders would have seen that state law required the auditor to publicly release such a substantial and unusual discovery of the administration’s flouting of federal law. Health and Human Services Commissioner Mary Mayhew defended her department’s actions in talk radio appearances last week, claiming that the behavior uncovered by the auditor — DHHS’ transfer of $13.4 million from one federal account to another, its use of the money on purposes not allowed by federal law, then its reversal of the transfer after the department’s misuse of the money became public — was merely “what you do throughout the year in managing a federal block grant.” In reality, DHHS’ actions are anything but normal behavior. A federal block grant is not a kitty the state can tap for whatever purpose it chooses, legal or not, as long as it returns the money once it becomes evident the state has violated federal law. Indeed, the fact that DHHS leaders consider that normal behavior was of major concern to Maine’s state auditor, whose responsibility is to ensure that the state spends money it receives from the federal government in accordance with federal regulations and that the state has sufficient accounting controls in place to prevent misspending. To read more –



The Hogan administration will ask the Board of Public Works to approve $82 million in spending cuts from the current state budget, including cuts to colleges and universities, local governments and Medicaid. The proposal, which will go to the board next week, reflects an expected revenue shortfall. The board is made up of Republican Gov. Larry Hogan and two Democrats, Comptroller Peter Franchot and Treasurer Nancy K. Kopp. Budget Secretary David R. Brinkley outlined the proposed reductions to the state’s $43 billion budget in a conference call Friday. He presented the action as part of Hogan’s strategy to address an expected budget gap of $175 million to $225 million. Brinkley echoed points raised by the General Assembly‘s chief budget analyst, Warren Deschenaux, at a briefing this week. Deschenaux, who in the past has been a target of Hogan administration criticism, had warned lawmakers that the state can’t continue to spend more than it is bringing in. To read more –



Gov. Charlie Baker is deferring any decision on mid-year budget cuts as the administration continues to monitor tax receipts. “We are closing the budget gap through fiscally prudent solutions such as unanticipated non-tax revenue and a voluntary separation incentive program,” Secretary of Administration and Finance Kristen Lepore said in a statement Thursday. Lepore said a couple of weeks ago that she believed the state needed to cut $294 million from executive branch spending due to lower than expected tax revenues and underfunding of some accounts in the state budget. But Democratic legislative leaders urged Baker to hold off on making budget cuts to see whether tax revenues pick up.  Lepore said Thursday that she anticipates using other methods to find the money. The administration is offering a voluntary buyout program to state workers, which administration officials hope will save $25 million in payroll costs. If it does not meet that target, there could be layoffs. Lepore wrote in a letter to the House and Senate Ways and Means Committee chairmen that efforts to rein in year-end spending in fiscal 2016 resulted in $145 million more than expected left over at the end of the year, which can be used this year. The state now anticipates getting higher federal reimbursements than expected. Since the School Building Assistance Authority and the MBTA both get money based on the amount of sales tax revenue that comes in, revised projections of sales tax revenues mean lower funding for each of those areas. Lepore warned that the state is continuing to monitor the potential underfunding of accounts, and it has identified a potential $100 million gap in the MassHealth budget, driven primarily by increased caseloads. She did not rule out making mid-year budget cuts later on. To read more –


New Hampshire

The Obama administration denied New Hampshire’s bid to make 50,000 low-income adults face a work requirement to receive taxpayer-paid coverage under an expansion of Medicaid. The decision, while expected in many quarters, was stunning in its timing coming on near the eve of an election in which this issue has been a hot topic for months.  The Centers for Medicare & Medicaid Services also rejected provisions of the 2015 New Hampshire Health Protection Program that would impose more rigorous standards to prove U.S. and New Hampshire citizenship to be eligible. “After reviewing New Hampshire’s amendment request to determine whether it meets these standards, CMS is unable to approve the following requests which could undermine access, efficiency, and quality of care provided to Medicaid beneficiaries,” said CMS Director Vikki Wachino in her letter to NH Health and Human Services Commissioner Jeffrey Meyers.  The program still stands precisely because the Republican-led Legislature narrowly agreed to set up this program with a clause that allowed it all to go forward even if parts of it were judged to be illegal or unconstitutional.Gov. Maggie Hassan’s spokesman said GOP lawmakers knew no state had been granted a work requirement and getting one for New Hampshire past federal regulators was at best a long shot. To read more –


New Mexico

Just days after Gov. Susana Martinez signed measures into law to eliminate unconstitutional budget deficits, lawmakers were greeted with a current operating budget that is still $100 million short and has no cash reserves, as well as a request for at least $80 million more in Medicaid funds for the next fiscal year. Wednesday’s meeting of the Legislative Finance Committee also came a day after a credit downgrade by Moody’s Investors Service, which lowered the bond rating for state borrowing. In a report issued Tuesday, Moody’s cited New Mexico’s volatile revenues and the rapid depletion of cash balances in its decision to change the state’s rating for general obligation bond debt from the top tier, AAA, to the agency’s second-highest rating, Aa1. The change will result in slightly higher borrowing costs, perhaps $200,000 a year, according to some economists. More important is that Moody’s lowered the long-term outlook of the state from stable to negative, which means state spending decisions face more scrutiny in the coming year, and an even lower credit rating is possible. During a recent special legislative session, lawmakers approved spending cuts to most state agencies and transfers of unspent money from several accounts into the state’s general fund to close shortfalls totaling more than $600 million for fiscal years 2016 and 2017. But the actions were not sufficient. Lawmakers learned Wednesday that updated estimates indicate state revenues for fiscal year 2017, which began in July, are still $100 million short of what’s needed. To read more –



Court-appointed special masters Friday released dozens of recommendations on how Texas should overhaul its troubled foster care system, including eliminating the use of foster care group homes, limiting the workload of caseworkers and proposing a plan to curb caseworker turnover rates.  The reports come after a federal judge ruled that the Texas foster care system is unconstitutional.  Court-appointed special masters issue dozens of recommendations.  The special masters’ recommendations include better reporting, care and caseworker retention.   “This is a hugely important day for Texas children because this is the next step in crucial reform of the foster care system,” said Paul Yetter, a Houston attorney who is representing foster children suing the state. In December, U.S. District Judge Janis G. Jack of Corpus Christi found the Texas foster care system unconstitutional following a years-long case and suggested that foster children were better off before they entered the system. Jack ordered the Texas Department of Family and Protective Services — which oversees the foster care system — to make some immediate changes and appoint special masters to recommend further ones. Those special masters, former New Jersey Commissioner of Children and Families Kevin Ryan and Francis McGovern, a Duke University law professor, made five dozen recommendations, which Jack will review and could force the agency to implement. Texas Department of Family and Protective Services chief Hank Whitman testifies at a Texas House Human Services Committee hearing in July. Patrick Crimmins, spokesman for the state’s child welfare agency, said the agency has been working to fix the foster care system, including finding more foster homes and ways to improve the health care of children, and ensuring caseworkers are spending more time with families and children. “The state of Texas has made improving foster care a priority and will continue to do so,” he said.  The New York-based advocacy group Children’s Rights sued the state on behalf of foster children in 2011, accusing the state’s child welfare agency of maintaining insufficient numbers of caseworkers, moving children too frequently and putting them at risk of abuse and neglect. Attorneys representing the state argued that Texas’ caseworker turnover rate and rate of foster placements with relatives and adoptions were comparable to other states. The state is appealing Jack’s ruling. Eight foster children died from abuse or neglect in foster homes in fiscal 2013, up from two the year before. In 2014, three died in foster care.  Kate Murphy with the advocacy group Texans Care for Children said that the special masters’ plan wouldn’t fix all the problems with the foster care system. She said the federal lawsuit and the special masters’ report only address children who are in foster care for at least a year and are permanently in the state’s custody — 10,795 of the state’s 30,000 foster care children as of Sept. 30, according to the state agency. “State leaders will have to do more to make sure that kids in foster care heal from the trauma they’ve already experienced and grow up healthy,” Murphy said. The state agency has reported that it has spent about $500,000 for the report.  “The preparation of the report and the further billable hours it recommends come at considerable expense to Texas taxpayers. Though the litigation has brought attention to a broken system, it will not fix foster care,” said Brandon Logan with conservative Austin-based Texas Public Policy Foundation think tank.  To read more –

Shannon McCracken is a leader when it comes to supporting the needs of people with developmental and intellectual disabilities. After a decade of experience at the two largest SCL agencies in Kentucky, she made the decision to embrace a new opportunity and start her own company, Commonwealth Case Management. While in the field, Shannon has won numerous national awards and served in multiple leadership positions, most recently with the Kentucky Association of Private Providers (KAPP). From November 2009 - 2012, she served as the Vice-President of Public Policy for the KAPP Board of Directors and served as President from 2012-2015. In 2016, KAPP made a significant investment in its future and offered Shannon a full-time position as the State Executive Director. Being so involved has enabled Shannon to stay at the leading edge and have a great understanding of what it takes to support people with disabilities.

Shannon is a graduate of Western Kentucky University...wife to Tony, mom to Davis (19) & Caroline (17.)

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